Mental Health Awareness: Persistent Depressive Disorder

Scientists have been studying the brain for generations, and yet understanding its complexities and intricacies remains elusive. Part of the problem with mental health awareness is that some people still believe that mental health is “all in your head”, or in other words, not real.

One particular mental health issue that is currently gaining recognition is persistent depressive disorder (PDD), also known as dysthymia or high functioning depression. It is a serious and disabling disorder that shares many symptoms with other forms of clinical depression, however it is experienced as a less severe but more chronic form of major depression.

PDD is characterized as a dominating depressed mood that is experienced for at least two years. In addition to this depressed mood, at least two of the following must also be present:

insomnia or excessive sleep

low energy or fatigue

low self-esteem

poor appetite or overeating

poor concentration or indecisiveness

feelings of hopelessness

The more severe symptoms that mark major depression, such as the inability to feel pleasure, lethargy and thoughts of death or suicide, are often absent in PDD. While PDD and Major Depressive Disorder are two different disorders, PDD can occur alone or in conjunction with other mood or psychiatric disorders. More than half of individuals who suffer from PDD will experience at least one episode of Major Depression. When PDD is accompanied by an episode of Major Depression, this is known as Double Depression. Those with PDD are also at a higher risk for anxiety and substance abuse disorders. Luckily, PDD is treated in a similar manner as other clinical depressions. Supportive therapy, psychotherapy and medication are all options for those struggling with PDD.

Persistent Depressive Disorder appears to have its roots in a combination of genetic, biochemical, environmental and psychological factors; chronic stress and trauma are common provocations as well. The ability to regulate one’s mood and prevent mild sadness from deepening and persisting is impaired by stress. Compounded by isolation and the unavailability of social support, chronic stress and social circumstances can contribute to the development of PDD. Trauma, such as loss of a loved one, a difficult relationship, or any other number of stressful situations may trigger a depressive episode. Once triggered, subsequent depressive episodes may occur with or without an obvious trigger. For the elderly, PDD is more likely the result of medical illness, cognitive decline, bereavement and physical disability. When looking at MRI scans of the brain, those with depression show that the parts responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally, and neurotransmitters appear to be out of balance when compared to the MRI image of a brain of a person without depression. While these images tell us much about what isn’t functioning properly in the brain, it still fails to tell us the what causes it.

The forbidding thing about PDD is how difficult it is to identify in someone, or even in yourself. People with PDD don’t always fit into the “mold” that we tend to put depressed individuals in. They aren’t necessarily gloomy all the time, isolating themselves or unable to function in school or work. Sometimes they are very active in their community, excelling at school or in work, and maintaining close and personal relationships with friends and family.

What’s so scary about a person who, according to all outward signs, is not being controlled by their depression? All of the news articles about suicide victims, where their friends and family are quoted as saying “they were such a happy person” or “I had no idea they were struggling.”

Many people with PDD do not get the treatment they need. Their struggle goes unnoticed by friends, family and even themselves, until it is too late. Awareness of PDD needs to be increased. PDD is real, and it is dangerous to ignore. There are too many people falling outside the radar of “classic” depression symptoms, and being left behind to fend for themselves.

If you think you might have PDD, see a therapist to see what treatment options will work for you.

Wright, A. (May 2017). What Are the Signs of ‘High-Functioning’ Depression and Could You Have It? The Mighty. Retrieved from https://themighty.com/2017/05/signs-of-high-functioning-depression-or-dysthymia/

Alison Morgan is an intern for The American Public Safety Training Institute. She will graduate from BYU-Idaho in mid-July with a Bachelors of Science in Health Science with an emphasis in Public Health. Next, Alison will work on getting accepted to a masters program in either scientific journalism, public health, or psychology. She hopes to serve as a bridge between people and science through the written word or through client/provider relationships.

BlueLine.news and BlueLineRadio.org are both services of The American Public Safety Training Institute, a 501(c)(3) non-profit training collaborative located at www.tapsti.org. We are 100% volunteer staffed and appreciate your donations.